Abstract
Despite the evidence of links between health expenditure and health care efficiency, it is still unclear why countries with similar levels of health expenditures experience different outputs in terms of life expectancy at birth. Health care system efficiency might shed some light on the question. Using output-oriented data envelopment analysis, we compared the health systems of 140 countries in terms of attained life expectancy. Efficiency is determined by the distance from the closest country on the best practice frontier, which identifies the highest attainable life expectancy observed for any given level of health care spending. By using national data form the Human Development Data, we built the efficiency frontier and computed the potential life expectancy increase for each country. The potential improvement was, on average, 5.47 years [95%CI: 4.71-6.27 years]. The least efficient countries (10th percentile of the efficiency score) could improve by 11.78 years, while the most efficient countries (90th percentile of the efficiency score) could only improve by 0.83 years. We then analyzed, with regression analysis stratified by average education level, and by the role of health-related variables in differentiating efficient and inefficient countries from each other. The results suggest that, among countries with lower levels of education, decreasing unemployment and income inequality increases average life expectancy, without increasing health expenditure levels.
Highlights
Longevity has been a cornerstone in public health and medical debates and life expectancy is often used to measure the health and well-being of a population [1]
In this study, building on the methodology applied in previous efficiency studies, we explore the efficiency of health care systems by estimating the contribution of health care spending to life expectancy
Given that we performed an output-oriented data envelopment analysis, efficiency is given by the vertical distance, which shows by how much life expectancy at birth could be increased while keeping the health expenditure level the same
Summary
Longevity has been a cornerstone in public health and medical debates and life expectancy is often used to measure the health and well-being of a population [1]. Over the last century life expectancy at birth has steadily increased everywhere [2]. Part of this increment was supported by improvements in clinical interventions [3,4,5,6]. Preston [8] showed that life expectancy and national GDP are positively correlated, with decreasing returns of life expectancy to income. The relationship between two aggregate measures, such as life expectancy and national gross domestic product (GDP), masks the impact of country specific characteristics
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